Appearance of acetylcholinesterase and creatine kinase in plasma of normal chickens after denervation

Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study

Objective

Amyotrophic lateral sclerosis (ALS) pathogenesis is still unclear, its course is considerably variable, and prognosis is hard to determine. Despite much research, there is still a lack of easily accessible markers predicting prognosis. We investigated routine blood parameters in ALS patients regarding correlations with disease severity, progression rate, and survival. Additionally, we analyzed disease and patients' characteristics relating to baseline blood parameter levels.

Methods

We analyzed creatine kinase (CK), albumin (ALB), creatinine (CREA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG) levels around time of diagnosis in 1,084 ALS patients. We carried out linear regression analyses including disease and patients' characteristics with each blood parameter to detect correlations with them. Linear regression models were performed for ALSFRS-R at study entry, its retrospectively defined rate of decay and prospectively collected progression rate. Different survival analysis methods were used to examine associations between blood parameters and survival.

Results

We found higher CK (p-value 0.001), ALB (p-value <0.001), CREA (p-value <0.001), and HDL levels (p-value 0.044) at time of diagnosis being associated with better functional status according to ALSFRS-R scores at study entry. Additionally, higher CREA levels were associated with lower risk of death (p-value 0.003).

Conclusions

Our results indicate potential of CK, ALB, CREA, and HDL as disease severity or progression markers, and may also provide clues to ALS pathogenesis. However, these values are highly dependent on other variables, and further careful, longitudinal analyses will be necessary to prove the relevance of our findings.

Aberrations of biochemical indicators in amyotrophic lateral sclerosis: a systematic review and meta-analysis

Accumulating evidence has suggested that the pathological changes in amyotrophic lateral sclerosis (ALS) are not only confined to the central nervous system but also occur in the peripheral circulating system. Here, we performed a meta-analysis based on the PubMed, EMBASE, EBSCO, and CNKI databases, to find out biochemical indicators associated with energy metabolism, iron homeostasis, and muscle injury that are altered in ALS patients and their correlations with ALS phenotypes. Forty-six studies covering 17 biochemical indicators, representing 5454 ALS patients and 7986 control subjects, were included in this meta-analysis. Four indicators, including fasting blood glucose level (weighted mean difference [WMD] = 0.13, 95% CI [0.06–0.21], p = 0.001), serum ferritin level (WMD = 63.42, 95% CI [48.12–78.73], p < 0.001), transferrin saturation coefficient level (WMD = 2.79, 95% CI [1.52–4.05], p < 0.001), and creatine kinase level (WMD = 80.29, 95% CI [32.90–127.67], p < 0.001), were significantly higher in the ALS patients, whereas the total iron-binding capacity (WMD = − 2.42, 95% CI [− 3.93, − 0.90], p = 0.002) was significantly lower in ALS patients than in the control subjects. In contrast, the other 12 candidates did not show significant differences between ALS patients and controls. Moreover, pooled hazard ratios (HR) showed significantly reduced survival (HR = 1.38, 95% CI [1.02–1.88], p = 0.039) of ALS patients with elevated serum ferritin levels. These findings suggest that abnormalities in energy metabolism and disruption of iron homeostasis are involved in the pathogenesis of ALS. In addition, the serum ferritin level is negatively associated with the overall survival of ALS patients.

Elevated serum creatine kinase in the early stage of sporadic amyotrophic lateral sclerosis

OBJECTIVE

To assess the changes of muscle-related biomarkers at the early stage of amyotrophic lateral sclerosis, and to confirm these findings in an experimental animal model.

METHODS

Thirty-nine subjects with sporadic amyotrophic lateral sclerosis and 20 healthy controls were enrolled and longitudinally evaluated. We evaluated serum creatine kinase and creatinine levels and appendicular lean soft-tissue mass using dual X-ray absorptiometry. The levels of biomarkers at early ALS stages were estimated using linear mixed models with unstructured correlation and random intercepts. We also analyzed the longitudinal changes of serum creatine kinase and creatinine, together with the mRNA levels of acetylcholine receptor subunit γ (Chrng) and muscle-associated receptor tyrosine kinase, markers of denervation, in the gastrocnemius muscle of superoxide dismutase 1 (SOD1)^G93A transgenic mice, an animal model of amyotrophic lateral sclerosis.

RESULTS

The estimated levels of creatine kinase were higher in subjects with amyotrophic lateral sclerosis at the early stage than in healthy controls, although the estimated appendicular lean soft-tissue mass and creatinine levels were equivalent between both groups, suggesting that the elevation of creatine kinase precedes both muscular atrophy and subjective motor symptoms in sporadic amyotrophic lateral sclerosis. In SOD1^G93A mice, the serum levels of creatine kinase were elevated at 9 weeks of age (peri-onset) when Chrng started to be up-regulated, and were then down-regulated at 15 weeks of age, consistent with the clinical data from patients with sporadic amyotrophic lateral sclerosis.

INTERPRETATION

Creatine kinase elevation precedes muscular atrophy and reflects muscle denervation at the early stage.

Creatine kinase level and its relationship with quantitative electromyographic characteristics in amyotrophic lateral sclerosis

OBJECTIVE

To explore the relationship between serum creatine kinase (CK) level and electromyographic characteristics in patients with amyotrophic lateral sclerosis (ALS).

METHODS

Two hundred thirty-eight consecutive ALS patients were enrolled. All patients underwent electrophysiological study with a consistent approach. We calculated a compound muscle action potential (CMAP) sum score, and spontaneous potentials were graded from 0 to 4 depending on their density and distribution. We tested for any independent correlation of the CK levels with CMAP sum score, mean spontaneous potential (MSP) score, F wave persistence or conduction velocity.

RESULTS

The median serum CK level was 151 U/L. Log CK was independently correlated with MSP score (β = 0.07, 95% CI: 0.01-0.14, p = 0.032) and F persistence (β = -0.0013, 95% CI: -0.00251 to -0.0002, p = 0.02) but not with CMAP sum score or F wave conduction velocity. When stratified by sex, the correlation of log CK with MSP score and F persistence was significant in male but not female patients.

CONCLUSIONS

The results support that lower motor neuron loss and muscle denervation are associated with elevated CK levels of ALS patients.

SIGNIFICANCE

The severity of lower motor neuron loss and denervation might be involved in pathophysiological mechanisms of CK elevation in ALS patients.

Creatine kinase enzyme level correlates positively with serum creatinine and lean body mass, and is a prognostic factor for survival in amyotrophic lateral sclerosis

BACKGROUND AND PURPOSE

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative condition for which there is no single diagnostic test or biomarker. The level of the creatine kinase (CK) enzyme in serum may be mild to moderately elevated in some patients with ALS, the precise cause of which and its behaviour with disease progression is unknown. The aim of this study was to examine the usefulness of monitoring CK serially during the ALS disease trajectory and to determine whether CK levels mirror disease progression.

METHODS

This was a prospective observational cohort study, using the clinical database of the olesoxime (TRO19622) investigational medicinal product trial.

RESULTS

The baseline CK was raised in 52% of the trial participants with the mean CK ± SD being 257 ± 239 U/l. The mean CK was significantly higher in male participants than in female participants (P < 0.001) and amongst participants with limb onset ALS compared to participants with bulbar onset ALS (P < 0.001). There was no significant difference in the CK levels between upper limb and lower limb onset disease (P = 0.746). The CK level co-related positively with serum creatinine and estimated lean body mass but there was no relationship between CK and muscle scores and limb function. A higher CKlog was associated with significantly better survival, even when adjusted for prognostic co-variants (P = 0.013).

CONCLUSIONS

The serum CK level seems to be an independent prognostic factor for survival in ALS. The cellular mechanism of CK enzyme suggests that it may be upregulated to provide energy in the face of metabolic stress in ALS.

Compartmentalization of acetylcholinesterase mRNA and enzyme at the vertebrate neuromuscular junction

Acetylcholinesterase (AChE) is concentrated at the vertebrate neuromuscular synapse. To determine whether increased transcript levels could underlie this selective accumulation, we employed a quantitative reverse transcription polymerase chain reaction-based assay to determine mRNA copy number in samples as small as single neuromuscular junctions (NMJs) and a microassay to measure AChE enzyme activity at single synapses. Our results show that AChE mRNA is an intermediate transcript at NMJs, whereas in noninnervated regions of muscle fibers, AChE transcripts are either undetectable or rare. In contrast, alpha-actin transcript levels in the same samples are similar in junctional and extrajunctional regions. However, compared with AChE enzyme activity and alpha-actin mRNA levels, the levels of AChE transcripts at NMJs are highly variable. These results indicate that AChE mRNA and protein expression are compartmentalized at the vertebrate NMJ and provide a direct approach toward dissecting the molecular events leading from synaptic activation to plastic changes in gene expression at single vertebrate synapses.

Toxicity of an acute dose of agent VX and other organophosphorus esters in the chicken

The neurotoxicities of single doses of a chemical warfare agent VX [phosphonothioic acid, methyl-S-(2-[bis(1-methylethyl)amino/ethyl) O-ethyl ester], a metabolite of the agricultural chemical parathion, paraoxon, PO (phosphonothioic acid, diethyl paranitrophenyl ester), and the known neuropathic agents DFP] phosphorofluoridic acid, bis(1-methylethyl) ester] and TOCP (phosphoric acid, tri-o-tolyl ester) were compared in the chicken. Single injections (subcutaneous, sc) of VX as high as 150 micrograms/kg (5 times the LD50, intramuscular, im) were tolerated by laying tens if atropine and 2-pralidoxime were used as antidotes before and immediately after injection. The 150 of VX for inhibition of chicken brain acetylcholinesterase was approximately 5 X 10(-10). Plasma acetylcholinesterase, but not butyrylcholinesterase, was depressed 2 h after injections of 2-20 micrograms VX/kg im without antidotes. Levels of plasma enzymes such as creatine kinase, indicative of tissue damage, were increased after exposure to both VX and PO. Injections of up to 150 micrograms/kg of VX with antidotes did not cause locomotor or histological signs of organophosphorus-induced delayed neuropathy, but single injections of 400 mg TOCP/kg did.

Percutaneous toxicity and delayed neurotoxicity of organophosphates in the scaleless hen

The acute toxicity of tri-ortho-cresyl phosphate (TOCP) and the development of delayed neurotoxicity were characterized in the scaleless hen, a featherless mutant, and compared to the responses observed in normally feathered birds. Brain acetylcholinesterase (AChE) activity was comparable between scaleless and normal hens, but nonspecific cholinesterase (ChE) activities of brain and plasma were significantly higher in scaleless birds. The acute ID50 of TOCP for plasma ChE activity was 690 mg/kg for scaleless birds and 240 mg/kg for normal ones following sc administration. However, there was no difference in the ID50 for plasma ChE activity between normal and scaleless hens treated sc with the active metabolite of TOCP, 2-(o-cresyl)-4H-1:3:2-benzodioxaphosphoran-2-one, or parathion. The onset of clinical signs of delayed neurotoxicity in scaleless birds was 8 to 14 days after sc or dermal treatment with TOCP and caused typical axonal fragmentation in the sciatic nerve. Plasma creatine phosphokinase activity was significantly increased following the onset of delayed neurotoxicity in both lines of birds. Dermal application of TOCP to a 50-cm2 area on the backs of scaleless hens inhibited plasma ChE activity in a dose-related manner (ID50 = 115 mg/kg), and the lowest dose of TOCP, 114 mg/kg, did not produce delayed neurotoxicity. The results show that the scaleless hen can be used to determine a no-observable effect level for delayed neurotoxicity which regulatory agencies could use to extrapolate a safe level of human dermal exposure to organophosphates that produce delayed neurotoxicity.

Molecular forms of cholinesterases in cerebrospinal fluid, blood plasma, and brain tissue of the beagle dog

In the present study we have investigated the activity of AChE and BuChE in the cisternal CSF of the Beagle dog and have outlined the characteristics of the molecular forms of both enzymes. The same enzymes were also investigated in samples from blood plasma and brain tissue. It is concluded that AChE in CSF originates from the spinal cord and brain tissues as a result of some secretory process. A combined origin from both blood plasma and brain tissue appears to be probable for the BuChE of the CSF.

Acetylcholinesterase activity in ventricular and cisternal CSF of dogs: effect of chlorpromazine

Acetylcholinesterase (AChE) activity in dog plasma is significantly higher than in either ventricular or cisternal CSF. However, since protein levels in plasma are about 100-fold higher than in CSF, the specific activity of AChE is lower in plasma than in CSF. Acetylcholinesterase activity in plasma represents only 22% of total cholinesterase (ChE) activity, while preliminary findings indicate that in ventricular CSF it is 50-60%. Acetylcholinesterase activity in ventricular CSF is significantly lower than in cisternal CSF. Chlorpromazine (10 mg/kg, intravenous), a drug which increases acetylcholine turnover, increased AChE-specific activity in all dogs. Our results support the hypothesis of a neuronal origin of AChE activity in CSF.

Effects of long term denervation on smooth muscle of the chicken expansor secundariorum

Denervation of the expansor secundariorum muscle of the adult and 2 week chicken, by sectioning the brachial plexus, resulted in an approximate twofold increase in dry weight over 8 weeks. Unlike skeletal muscle, no ultrastructural changes were exhibited by the smooth muscle cells for a period of up to 5 months post denervation. No evidence of hypertrophy of the individual muscle cells was observed, but following colchicine treatment a definite increase in the number of mitotic figures was noted within muscle bundles indicating that the increase in dry weight of the expansor muscle is due to hyperplasia of the smooth muscle cells. The results are discussed in relation to in vitro studies of the interaction of sympathetic nerves with smooth muscle.